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Congenital Heart Defects

Congenital Heart Defects. Incidence. Congenital heart disease affects 8 in 1,000 births Varies in severity Can be associated with genetic syndromes (Down, DiGeorge , velocardiofacial ). Ventricular Septal Defect. Hole between the two ventricles Left to right shunt( acyanotic )

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Congenital Heart Defects

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  1. Congenital Heart Defects

  2. Incidence • Congenital heart disease affects 8 in 1,000 births • Varies in severity • Can be associated with genetic syndromes (Down, DiGeorge, velocardiofacial)

  3. Ventricular Septal Defect • Hole between the two ventricles • Left to right shunt(acyanotic) • Usually requires surgical repair-causes LVH

  4. VSD, continued • Most common heart lesion (30%) • Usually manifests in first weeks of birth • Most resolve spontaneously in 1st years of life • Findings: holosystolic murmur best heard at LLSB, may have palpable thrill

  5. Atrial Septal Defect • Hole between the atria • Usually asymptomatic • Starts as left to right shunt (acyanotic)

  6. ASD findings • Grade II-IV systolic ejection murmur at LUSB • Louder with a smaller defect (turbulence) • Fixed splitting of S2 • ECG/echo: RVH if uncorrected • If uncorrected: • RAH, pulmonary hypertension increases pressure on right side of heart • Shunts right to left(cyanotic)

  7. Patent DuctusArteriosus • Ductusarteriosus does not close • Oxygenated blood back to lungs • Common in preemies • May have no early symptoms

  8. PDA, continued • Grade II-IV holosystolic machinery murmur @ LUSB • ECG/echo: LVH or BiVH • If severe, CHF • Increased pulmonary vascular markings • Treatment: indomethacin or surgical closure

  9. Transposition of the Great Arteries Aorta comes out of right ventricle (cyanotic)

  10. TGA exam findings • Usually “blue baby” • If large VSD, may turn blue when crying/agitated and CHF symptoms • Murmurs vary depending on defect(s) • “Egg on a string”

  11. TGA treatment • Initially, medical management (prostaglandins)to keep intracardiac shunts open (if available) • Surgical correction definitive treatment

  12. Tetralogy of Fallot • Large VSD • Pulmonary stenosis • Overriding aorta • Positioned directly over VSD—unoxegenated blood to circulation • RVH

  13. Tetralogy of Fallot findings • Loud systolic ejection click @ M-LUSB • ECG: right axis deviation and RVH • X-ray: boot-shaped heart, no pulmonary vascular markings • Tet spells (cyanosis, crouching)

  14. Aortic Stenosis • Stenotic aortic valve • Findings • Grade II-IV systolic ejection click, does not vary with respirations • Thrill at RUSB • LVH if untreated • CHF if severe

  15. Pulmonic stenosis • Grade II-V systolic ejection click best heard at LUSB • Increases with expiration, decreases with inspiration • Thrill at LUSB radiating to back and sides

  16. Coarctation of the Aorta • II-IV systolic ejection murmur radiating to left interscapular • BP in lower extremities lower than upper • X-ray: rib notching

  17. Questions or comments? Thank you for viewing my presentation!

  18. References • Besides our Barkley book and wikipedia: • http://www.ojrd.com/content/3/1/27

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